BC Advantage - 2025 Issue 5

Underpayments: Causes, Implications, and Recovery

From large acute systems to ambulatory practices, healthcare organizations are plagued by an often-overlooked but significant revenue challenge: underpayments.   Occurring when payors fail to reimburse the full eligible amount for healthcare services provided, underpayments are a multifaceted issue requiring a combination of resources, expertise, technology, and collaboration between healthcare organizations and payors to resolve. By proactively identifying and addressing underpayments, healthcare provider organizations can protect their financial health and ensure fair reimbursement for the critical services they provide to patients.   Root Causes   The primary causes of underpayment can be categorized into four key areas: individuals, processes...

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